Provider Demographics
NPI:1043326838
Name:BETH JANE WILLIAMS
Entity type:Organization
Organization Name:BETH JANE WILLIAMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:M A R D
Authorized Official - Phone:207-284-4586
Mailing Address - Street 1:322A ELM ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3009
Mailing Address - Country:US
Mailing Address - Phone:207-284-4586
Mailing Address - Fax:207-286-3273
Practice Address - Street 1:322A ELM ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3009
Practice Address - Country:US
Practice Address - Phone:207-284-4586
Practice Address - Fax:207-286-3273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MED1791133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty